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SAN. JOAQUIN Environmental Health Department <br /> --COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ` I L Inspector: l 1 CL FM ��J CONSTRUCTION <br /> Facility Address: 5 &OIkI&I �'► �, <br /> Well Address: I Total Depth: <br /> WP# 00" q 105 Well#: Drilling Rig Type: <br /> Soil Boring#: 01 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: C Screen Length From: To: <br /> Consultant: 'rP,irrac�v� <br /> Filter Pack From: To: <br /> Geologist: ea"A Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: t1l height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION CCOMP=CN <br /> Method: Ground Surf ac* If <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> n. <br /> tt. <br /> SPOILS <br /> r — a <br /> Contamination Noted: ❑ Yes ❑NoAl <br /> If yes, spoils storage Location: <br /> slotted ` <br /> &*Cdon — B <br /> Covered: ❑ Yes El No = gravio+sack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:{ 4 _ <br /> Depth to Water: 0 0 _fL n <br /> Grout Material:. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 3 QAklayL5 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ®Boring Destruction Bags iz Cement: <br /> METHOD USED 6 ,h, LWYtt'{� Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> 9 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 10 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> jLa 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />